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Sood A, Kuo YF, Westra J, Sharma G, Raji MA. Co-prescribing of Central Nervous System-Active Medications for COPD Patients: Impact on Emergency Room Visits and Hospitalization. Ann Pharmacother 2023; 57:382-396. [PMID: 35942598 PMCID: PMC10508332 DOI: 10.1177/10600280221113299] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Anxiety and chronic pain are common comorbidities in patients with chronic obstructive pulmonary disease (COPD), which are frequently managed with benzodiazepines (BZDs) and opioids, respectively. OBJECTIVE The purpose of this study was to determine whether different combinations of opioids, BZD, and their substitutes-gabapentinoids (GABA) and selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors (SSRIs/SNRIs)-are associated with lower risk of acute respiratory events in COPD patients with co-occurring chronic pain and anxiety. METHODS This retrospective cohort study used a nationally representative sample of Medicare beneficiaries with COPD, chronic pain, and anxiety. Patients were grouped based on drug combination (opioid + BZD/Z-hypnotics, opioid + GABA, opioid + SSRI/SNRI, BZD/Z-hypnotics + GABA, BZD/Z-hypnotics + SSRI/SNRI, GABA + SSRI/SNRI, or ≥3 drugs). The primary outcome was emergency room (ER) visit or hospitalization due to acute respiratory events assessed up to 180 days following initiation of drug combination. Overdose secondary to central nervous system (CNS)-related drugs was also assessed up to 180 days following initiation of drug combination. RESULTS The drug combination opioid + GABA was associated with decreased risk for ER visit (hazard ratio [HR] = 0.73; 95% CI = 0.61-0.87) and hospitalization (HR = 0.69; 95% CI = 0.55-0.85). Opioid + SSRI/SNRI also showed decreased risk for ER visit (HR = 0.84; 95% CI = 0.71-0.99). There was no significant difference in risk for CNS-related drug overdose among different drug combinations compared with opioid + BZD/Z-hypnotics. CONCLUSION AND RELEVANCE Opioids in combination with GABA and SSRI/SNRI demonstrate relatively lower risk for acute respiratory events among patients with COPD and comorbid chronic pain and anxiety. The findings emphasize the need for multimodal management in this vulnerable population.
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Affiliation(s)
- Akhil Sood
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, 77555-01777
| | - Yong-Fang Kuo
- Department of Preventive Medicine & Population Health, University of Texas Medical Branch, Galveston, TX, 77555-01777
| | - Jordan Westra
- Department of Preventive Medicine & Population Health, University of Texas Medical Branch, Galveston, TX, 77555-01777
| | - Gulshan Sharma
- Department of Pulmonary, Critical Care, & Sleep Medicine, University of Texas Medical Branch, Galveston, TX, 77555-01777
| | - Mukaila A. Raji
- Department of Geriatric Medicine, University of Texas Medical Branch, Galveston, TX, 77555-01777
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Foley HE, Knight JC, Ploughman M, Asghari S, Audas R. Association of chronic pain with comorbidities and health care utilization: a retrospective cohort study using health administrative data. Pain 2021; 162:2737-2749. [PMID: 33902092 DOI: 10.1097/j.pain.0000000000002264] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/09/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Health administrative data provide a potentially robust information source regarding the substantial burden chronic pain exerts on individuals and the health care system. This study aimed to use health administrative data to estimate comorbidity prevalence and annual health care utilization associated with chronic pain in Newfoundland and Labrador, Canada. Applying the validated Chronic Pain Algorithm to provincial Fee-for-Service Physician Claims File data (1999-2009) established the Chronic Pain (n = 184,580) and No Chronic Pain (n = 320,113) comparator groups. Applying the Canadian Chronic Disease Surveillance System coding algorithms to Claims File and Provincial Discharge Abstract Data (1999-2009) determined the prevalence of 16 comorbidities. The 2009/2010 risk and person-year rate of physician and diagnostic imaging visits and hospital admissions were calculated and adjusted using the robust Poisson model with log link function (risks) and negative binomial model (rates). Results indicated a significantly higher prevalence of all comorbidities and up to 4 times the odds of multimorbidity in the Chronic Pain Group (P-value < 0.001). Chronic Pain Group members accounted for 58.8% of all physician visits, 57.6% of all diagnostic imaging visits, and 54.2% of all hospital admissions in 2009/2010, but only 12% to 16% of these were for pain-related conditions as per recorded diagnostic codes. The Chronic Pain Group had significantly higher rates of physician visits and high-cost hospital admission/diagnostic imaging visits (P-value < 0.001) when adjusted for demographics and comorbidities. Observations made using this methodology supported that people identified as having chronic pain have higher prevalence of comorbidities and use significantly more publicly funded health services.
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Affiliation(s)
- Heather E Foley
- Centre for Pain and Disability Management, Adult Rehabilitation, Geriatrics and Palliative Care Program, Eastern Regional Health Authority, St. John's, NL, Canada
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - John C Knight
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
- Analytics and Information Services Department, Newfoundland and Labrador Centre for Health Information, St. John's, NL, Canada
| | - Michelle Ploughman
- Division of Biomedical Sciences, Physical Medicine and Rehabilitation, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Shabnam Asghari
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
- Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Richard Audas
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
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Latiers F, Vandenabeele M, Poncin W, Reychler G. Prevalence and risk factors of musculoskeletal pain in patients with chronic obstructive pulmonary disease: A systematic review. CLINICAL RESPIRATORY JOURNAL 2021; 15:1286-1301. [PMID: 34459145 DOI: 10.1111/crj.13443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/14/2021] [Accepted: 08/25/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This systematic review aimed to discuss the prevalence and the risk factors of the musculoskeletal pain in chronic obstructive pulmonary disease (COPD). DATA SOURCE AND STUDY SELECTION Four databases were analysed (Scopus, PubMed, Cochrane and EMBASE). We excluded systematic reviews, meta-analyses, conference abstracts and case reports. Two authors independently checked for the eligibility of the relevant articles. The risk of bias was evaluated using the Newcastle Ottawa Quality Assessment Scale and the Joanna Briggs Institute critical appraisal checklist. The selection and evaluation of studies followed the PRISMA guidelines. RESULTS Twenty studies were retrieved, including from 21 to 7952 patients with COPD. The prevalence of pain was highly heterogeneous across studies: 7-89.7%. Pain was mostly reported in the lumbar (7-69%) and cervical spine (11-48.3%) and the chest (44-82.8%). The main risk factors for developing pain were old age, sex (female), level of physical activity (low) and comorbidities. CONCLUSION Pain is a very common symptom in patients with COPD. Despite this, few clinical trials have investigated the pain. It appears to be located primarily in the lumbar, cervical and thoracic regions and facilitated by being a female, a low level of physical activity, comorbidity(ies) and old age.
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Affiliation(s)
- Fabien Latiers
- Service de Chirurgie Thoracique et Vasculaire, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,Faculté des Sciences de la Motricité, Université Catholique de Louvain, Louvain-la-Neuve, Belgium.,Secteur de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Marie Vandenabeele
- Faculté des Sciences de la Motricité, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - William Poncin
- Secteur de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Brussels, Belgium.,Service de Pneumologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Gregory Reychler
- Secteur de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Brussels, Belgium.,Service de Pneumologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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4
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Raphaely RA, Mongiardo MA, Goldstein RL, Robinson SA, Wan ES, Moy ML. Pain in Veterans with COPD: relationship with physical activity and exercise capacity. BMC Pulm Med 2021; 21:238. [PMID: 34266401 PMCID: PMC8280683 DOI: 10.1186/s12890-021-01601-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pain is a common but underappreciated symptom experienced by people with Chronic Obstructive Pulmonary Disease (COPD). The relationships between pain and physical activity (PA) and exercise capacity are poorly understood. METHODS This retrospective secondary analysis includes three cohorts of Veterans with COPD who participated in longitudinal studies evaluating PA and exercise capacity with objective measures of daily step counts and 6-min walk test (6MWT) distance, respectively. Pain was assessed using the bodily pain domain of the Veterans RAND-36. In two cohorts, participants were randomly assigned to a web-based, pedometer-mediated PA intervention which has previously been demonstrated to improve PA. RESULTS Three-hundred and seventy-three (373) unique study participants were included in this analysis. Eighty-three percent (n = 311) of the population reported at least mild pain and/or at least a little bit of interference due to pain at baseline. Cross-sectionally, greater bodily pain was associated with lower 6MWT distance (β = 0.51; 95% CI 0.20, 0.82; p = 0.0013). Longitudinally, worsening bodily pain was associated with a decline in 6MWT distance (β = 0.30; 95% CI 0.03, 0.58; p = 0.0312). There was no association between baseline bodily pain and baseline daily step counts, baseline bodily pain and change in PA, or change in bodily pain and change in PA. Compared to usual care, our PA intervention improved bodily pain scores (β = 6.17; 95% CI 1.84, 10.45; p = 0.0054). Bodily pain scores did not affect the impact of the intervention on daily step counts. CONCLUSION Pain is highly prevalent and significantly associated with lower exercise capacity among Veterans with COPD. Worsening pain co-occurred with decline in exercise capacity but not PA. Our intervention reduced pain, although pain did not affect the impact of the intervention on PA.
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Affiliation(s)
- Rebecca A Raphaely
- Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, 1400 VFW Parkway, Mail Code 111P, Boston, MA, 02132, USA
- Department of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA, USA
- Department of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Maria A Mongiardo
- Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, 1400 VFW Parkway, Mail Code 111P, Boston, MA, 02132, USA
| | - Rebekah L Goldstein
- Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, 1400 VFW Parkway, Mail Code 111P, Boston, MA, 02132, USA
| | - Stephanie A Robinson
- Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, 1400 VFW Parkway, Mail Code 111P, Boston, MA, 02132, USA
- VA Bedford Healthcare Systems, Bldg 70, 200 Springs Rd, Bedford, MA, 01732, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Emily S Wan
- Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, 1400 VFW Parkway, Mail Code 111P, Boston, MA, 02132, USA
- Harvard Medical School, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Marilyn L Moy
- Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, 1400 VFW Parkway, Mail Code 111P, Boston, MA, 02132, USA.
- Harvard Medical School, Boston, MA, USA.
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5
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Fuentes-Alonso M, López-de-Andrés A, Palacios-Ceña D, Jimenez-Garcia R, Lopez-Herranz M, Hernandez-Barrera V, Perez-Farinos N, Ji Z, de-Miguel-Diez J. COPD is Associated with Higher Prevalence of Back Pain: Results of a Population-Based Case-Control Study, 2017. J Pain Res 2020; 13:2763-2773. [PMID: 33173326 PMCID: PMC7646454 DOI: 10.2147/jpr.s271713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/29/2020] [Indexed: 12/12/2022] Open
Abstract
Objective We aimed to assess whether patients suffering from COPD have a higher prevalence of chronic back pain (neck and low back pain) than age-, sex-, and residence-matched non-COPD controls. We also aimed to identify which variables are associated with chronic neck pain (CNP) and chronic low back pain (CLBP) among COPD patients. Methods We carried out a retrospective case-control study using data obtained from the Spanish National Health Survey conducted in 2017. Results We analyzed data from 1034 COPD and 1034 matched non-COPD controls. The prevalence of CNP and CLBP was 38.20% and 45.16%, respectively, among COPD patients and 22.82% and 28.34% for non-COPD controls, respectively (p<0.001 for both). Multivariable analysis showed that COPD patients had a 1.62-fold (95% CI 1.50-1.74) higher risk of CNP and a 1.83-fold (95% CI 1.73-1.91) higher risk of CLBP than non-COPD controls. Experiencing one type of pain greatly increased the risk of having the other. Factors associated with the presence of both types of pain among COPD patients included female sex, "fair/poor/very poor" self-rated health, migraine or frequent headache and use of pain medication. Being aged from 70 to 79 years was a risk factor for CLBP, and suffering from a mental disorder was a risk factor for CNP. Conclusion The prevalence of CNP and CLBP was significantly higher among COPD patients than among non-COPD controls after adjusting for age, sex and other relevant clinical variables. Our findings add new data to the knowledge of chronic pain in COPD patients.
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Affiliation(s)
- Marta Fuentes-Alonso
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Ana López-de-Andrés
- Department of Medical Specialties and Public Health, Universidad Rey Juan Carlos, Madrid, Spain
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Universidad Rey Juan Carlos, Madrid, Spain
| | - Rodrigo Jimenez-Garcia
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Marta Lopez-Herranz
- Faculty of Nursing, Physiotherapy and Podology, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Napoleon Perez-Farinos
- Department of Public Health and Psychiatry, Faculty of Medicine, Universidad de Málaga, Málaga, Spain
| | - Zichen Ji
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Javier de-Miguel-Diez
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
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6
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Erlenwein J, Pfingsten M, Hüppe M, Seeger D, Kästner A, Graner R, Petzke F. [Management of patients with chronic pain in acute and perioperative medicine : An interdisciplinary challenge]. Anaesthesist 2020; 69:95-107. [PMID: 31932857 DOI: 10.1007/s00101-019-00708-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Chronic pain is a frequent comorbidity of patients in hospitals and has an influence on the clinical course and the duration of hospitalization. There is a need to have a better understanding of chronic pain as a comorbidity and it should be considered to a greater extent in understanding diseases, in treatment concepts and hospital structures to ensure a resource-oriented and high-quality care. This begins on admission by identifying pre-existing pain and related risk factors with the medical history and taking these into account in the treatment regimen. A multimodal treatment approach that involves medicinal, educational, psychological and physiotherapeutic expertise is required in these patients. A unimodal approach in the treatment is not effective. A pain physician should be involved in the treatment team as early as possible. Furthermore, psychological joint supervision should be available for these patients as several studies have demonstrated positive perioperative effects of psychological approaches on the treatment in this patient group.
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Affiliation(s)
- J Erlenwein
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
| | - M Pfingsten
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - M Hüppe
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - D Seeger
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - A Kästner
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - R Graner
- Klinik für Psychiatrie und Psychotherapie, Asklepios Fachklinikum Tiefenbrunn, Rosdorf, Deutschland
| | - F Petzke
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
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de Miguel Díez J, Jiménez García R, López de Andrés A. Living with COPD: Pain is Important Too. Arch Bronconeumol 2019; 56:351-352. [PMID: 31672342 DOI: 10.1016/j.arbres.2019.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/24/2019] [Accepted: 08/29/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Javier de Miguel Díez
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España.
| | - Rodrigo Jiménez García
- Departamento de Salud Pública y Materno Infantil, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Ana López de Andrés
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, España
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Prevalence of Pain in COPD Patients and Associated Factors: Report From a Population-based Study. Clin J Pain 2019; 34:787-794. [PMID: 29485534 DOI: 10.1097/ajp.0000000000000598] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the prevalence of chronic neck pain (CNP), chronic low back pain (CLBP), and migraine among Spanish adults with chronic obstructive pulmonary disease (COPD) compared with non-COPD patients matched by age and sex; and to identify predictors for each of these types of pains among COPD sufferers. MATERIALS AND METHODS A cross-sectional study conducted with data collected from the European Health Interview Surveys for Spain (EHSS) conducted in years 2009/2010 (n=22,188) and 2014 (n=22,842). Data were analyzed using multivariable logistic models. RESULTS The prevalence of COPD among patients aged 35 years or above were 7.6% (n=1328) for the EHSS 2009 and 5.4% (n=1008) for the EHSS 2014. We matched 2251 COPD patients with age and sex controls. The prevalence of all types of pain were significantly higher among those suffering COPD than those without COPD. For CNP the figures were 40.5% versus 26.1%, for CLBP 44.8% versus 28.4%, and for migraine 22.5% versus 13.2%. Multivariable analysis showed that COPD was associated to a 1.21 (95% confidence interval [CI], 1.02-1.45) higher risk of CNP, 1.38 (95% CI, 1.16-1.64) of CLBP, and 1.36 (95% CI, 1.12-1.65) of migraine. Associated factors with the presence of these types of pain among COPD patients included younger age (not for CLBP), female sex (not for CLBP), "fair/poor/very poor" self-rated health (not for migraine), high blood pressure (not for CNP), mental disorders, obesity (not for migraine), and use of pain medication. DISCUSSION The prevalence of CNP, CLBP, and migraine was significantly higher among COPD patients in comparison with controls. Associated factors to suffering these types of pain in patients with COPD included age, sex, self-rated health, certain comorbidities including mental disorders, obesity, and using pain medication.
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9
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Lewthwaite H, Williams G, Baldock KL, Williams MT. Systematic Review of Pain in Clinical Practice Guidelines for Management of COPD: A Case for Including Chronic Pain? Healthcare (Basel) 2019; 7:healthcare7010015. [PMID: 30678205 PMCID: PMC6473434 DOI: 10.3390/healthcare7010015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/10/2019] [Accepted: 01/19/2019] [Indexed: 12/11/2022] Open
Abstract
Chronic pain is highly prevalent and more common in people with chronic obstructive pulmonary disease (COPD) than people of similar age/sex in the general population. This systematic review aimed to describe how frequently and in which contexts pain is considered in the clinical practice guidelines (CPGs) for the broad management of COPD. Databases (Medline, Scopus, CiNAHL, EMbase, and clinical guideline) and websites were searched to identify current versions of COPD CPGs published in any language since 2006. Data on the frequency, context, and specific recommendations or strategies for the assessment or management of pain were extracted, collated, and reported descriptively. Of the 41 CPGs (English n = 20) reviewed, 16 (39%) did not mention pain. Within the remaining 25 CPGs, pain was mentioned 67 times (ranging from 1 to 10 mentions in a single CPG). The most frequent contexts for mentioning pain were as a potential side effect of specific pharmacotherapies (22 mentions in 13 CPGs), as part of differential diagnosis (14 mentions in 10 CPGs), and end of life or palliative care management (7 mentions in 6 CPGs). In people with COPD, chronic pain is common; adversely impacts quality of life, mood, breathlessness, and participation in activities of daily living; and warrants consideration within CPGs for COPD.
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Affiliation(s)
- Hayley Lewthwaite
- Alliance for Research in Exercise, Nutrition and Activity, School of Health Sciences, Division of Health Sciences, University of South Australia, Adelaide 5001, Australia.
| | - Georgia Williams
- Alliance for Research in Exercise, Nutrition and Activity, School of Health Sciences, Division of Health Sciences, University of South Australia, Adelaide 5001, Australia.
| | - Katherine L Baldock
- Australian Centre for Precision Health, School of Health Sciences, Division of Health Sciences, University of South Australia, Adelaide 5001, Australia.
| | - Marie T Williams
- Alliance for Research in Exercise, Nutrition and Activity, School of Health Sciences, Division of Health Sciences, University of South Australia, Adelaide 5001, Australia.
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10
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Zorgdrager M, Lange JFM, Krikke C, Nieuwenhuijs GJ, Hofker SH, Leuvenink HGD, Pol RA. Chronic Inguinal Pain After Kidney Transplantation, a Common and Underexposed Problem. World J Surg 2017; 41:630-638. [PMID: 27637606 PMCID: PMC5258796 DOI: 10.1007/s00268-016-3713-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The incidence and impact of chronic inguinal pain after kidney transplantation is not clearly established. A high incidence of pain after inguinal hernia repair, a comparable surgical procedure, suggests an underexposed problem. METHODS Between 2011 and 2013, 403 consecutive patients who underwent kidney transplantation were invited to complete the Caroline Comfort Scale (CCS) and Visual Analog Scale (VAS) in order to assess the incidence of chronic inguinal pain and movement disabilities, complemented by questions regarding comorbidity during follow-up. RESULTS The response rate was 58 % (n = 199) with a median follow-up of 22 months (IQR 12-30). In total, 90 patients (45 %) reported a CCS > 0 and 64 patients (32 %) experienced at least mild but bothersome complaints. Most inguinal complaints were reported during bending over and walking with a mean CCS score of 1.1 (SD ± 2.2) and 1.2 (SD ± 2.4), respectively. A high body mass index (BMI), delayed graft function, and the need for a second operation were associated with a higher CCS score on univariate analysis. Using multivariate analysis, only BMI (p = 0.02) was considered an independent risk factor for chronic inguinal pain. CONCLUSIONS The incidence of chronic inguinal pain is a common though underexposed complication after kidney transplantation. More awareness to prevent neuropathic pain seems indicated.
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Affiliation(s)
- Marcel Zorgdrager
- Department of Surgery, Division of Transplant Surgery, University Medical Center Groningen, University of Groningen, P.O. Box 30 001, 9700 RB Groningen, The Netherlands
| | - Johan. F. M. Lange
- Department of Surgery, Division of Transplant Surgery, University Medical Center Groningen, University of Groningen, P.O. Box 30 001, 9700 RB Groningen, The Netherlands
| | - Christina. Krikke
- Department of Surgery, Division of Transplant Surgery, University Medical Center Groningen, University of Groningen, P.O. Box 30 001, 9700 RB Groningen, The Netherlands
| | - Gertrude. J. Nieuwenhuijs
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sybrand. H. Hofker
- Department of Surgery, Division of Transplant Surgery, University Medical Center Groningen, University of Groningen, P.O. Box 30 001, 9700 RB Groningen, The Netherlands
| | - Henri. G. D. Leuvenink
- Department of Surgery, Division of Transplant Surgery, University Medical Center Groningen, University of Groningen, P.O. Box 30 001, 9700 RB Groningen, The Netherlands
| | - Robert A. Pol
- Department of Surgery, Division of Transplant Surgery, University Medical Center Groningen, University of Groningen, P.O. Box 30 001, 9700 RB Groningen, The Netherlands
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11
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Zhou X, Li J, Gu W, Wang J, Zhu Y, Zhang G, Ding Y, Tang Y. Prevalence and associated factors of anxiety and depression among patients with chronic respiratory diseases in eight general hospitals in Jiangsu Province of China: A cross-sectional study. Psychiatry Res 2017; 251:48-53. [PMID: 28189078 DOI: 10.1016/j.psychres.2017.01.070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 01/21/2017] [Accepted: 01/22/2017] [Indexed: 01/04/2023]
Abstract
Anxiety and depression are two common psychological disorders with high morbidity worldwide. Understanding of their prevalence of patients with chronic respiratory diseases is becoming more and more important for clinicians. The current study aims at investigation of the prevalence and potential risk factors of anxiety and depression among patients with chronic respiratory diseases. The psychological status, anxiety and depression, and the relevant risk factors of 1713 patients with chronic respiratory diseases from 8 general hospitals in Jiangsu Province of China were evaluated. The results showed that the patients with chronic respiratory diseases experiencing depression and anxiety accounted for 46.00% and 25.34%, respectively. Multivariate logistic regression analysis revealed that lower body mass index (BMI), sleep disorders, limitation of physical activity, and negative life events were significantly associated with an increased risk of both depressive and anxiety symptoms. Poor marital status including divorce, separation and widowerhood was markedly correlated with an increased risk of depression, and chronic pain was with anxiety symptoms, respectively. Collectively, the data demonstrated that depression and anxiety were highly prevalent among the patients with chronic respiratory diseases. It is greatly significant to take specific psychological measures to lower the incidence of depression and anxiety in these patients.
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Affiliation(s)
- Xianmei Zhou
- Jiangsu Province Hospital of Traditional Chinese Medicine (TCM), Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210000, China.
| | - Jiashu Li
- Lianyungang First People's Hospital, Lianyungang 222000, China
| | - Wei Gu
- Nanjing First Hospital, Nanjing 210000, China
| | - Jian Wang
- Zhenjiang First People's Hospital, Zhenjiang 212000, China
| | - Yimin Zhu
- Jiangsu Province Second Hospital of TCM, Nanjing 210000, China
| | - Guicai Zhang
- Yancheng Hospital of TCM, Yancheng 224000, China
| | | | - Yanfen Tang
- Nantong Hospital of TCM, Nantong 226000, China
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Ferguson GT, Karpel JP, Clerisme-Beaty E, Grönke L, Voß F, Buhl R. Efficacy and safety of tiotropium + olodaterol maintenance treatment in patients with COPD in the TONADO ® and OTEMTO ® studies: a subgroup analysis by age. Int J Chron Obstruct Pulmon Dis 2016; 11:2701-2710. [PMID: 27843306 PMCID: PMC5098524 DOI: 10.2147/copd.s108758] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Increasing age is associated with poor prognosis in patients with COPD. Objective This analysis from the replicate Phase III OTEMTO® and TONADO® studies examined the efficacy and safety of tiotropium, a long-acting anticholinergic, combined with olodaterol, a long-acting β2-agonist, compared to monotherapies and placebo in patients with COPD aged 40 years to <65 years, 65 years to <75 years, 75 years to <85 years, and ≥85 years. Methods In these double-blind, parallel-group, active-controlled, multicenter, randomized studies, patients received tiotropium + olodaterol 2.5/5 μg or 5/5 μg, tiotropium 5 μg or 2.5 μg (TONADO only), olodaterol 5 μg (TONADO only), or placebo (OTEMTO only). This analysis used the approved doses of tiotropium + olodaterol 5/5 μg, tiotropium 5 μg, and olodaterol 5 μg. Primary end points at 12 weeks (OTEMTO) or 24 weeks (TONADO) included St George’s Respiratory Questionnaire (SGRQ) total score, forced expiratory volume in 1 second (FEV1) area under the curve from 0 hour to 3 hours (AUC0–3) response, and trough FEV1 response. Results A total of 1,621 patients were randomized (40 years to <65 years, n=749; 65 years to <75 years, n=674; 75 years to <85 years, n=186; ≥85 years, n=12) in OTEMTO and 5,162 patients (40 years to <65 years, n=2,654; 65 years to <75 years, n=1,967; 75 to <85 years, n=528; ≥85 years, n=13) in TONADO. FEV1 AUC0–3 and trough FEV1 responses improved with tiotropium + olodaterol 5/5 μg at 12 weeks and 24 weeks compared to monotherapies or placebo for all age groups. SGRQ scores generally improved with tiotropium + olodaterol 5/5 μg after 12 weeks in OTEMTO and improved after 24 weeks in all age groups in TONADO. In all age groups receiving tiotropium + olodaterol 5/5 μg compared to monotherapies or placebo, transition dyspnea index scores generally improved, while rescue medication usage improved. Conclusion No differences were noted in relative responses to treatment or safety when using tiotropium + olodaterol 5/5 μg compared to monotherapies or placebo across all age groups.
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Affiliation(s)
- Gary T Ferguson
- Pulmonary Research Institute of Southeast Michigan, Farmington Hills, MI
| | | | | | - Lars Grönke
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein
| | - Florian Voß
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein
| | - Roland Buhl
- Pulmonary Department, Mainz University Hospital, Mainz, Germany
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